title: Drug and alcohol use complicate traumatic peripheral vascular injury.
abstract: BACKGROUND
  Drug and alcohol use complicate the presentation and management of traumatic injuries. Impaired hemodynamic recovery and host defense in substance users also predispose these patients to worse outcomes after trauma. We hypothesized that substance abuse, particularly when drugs and alcohol are combined, complicates the presentation, management, and patient outcomes following isolated traumatic peripheral vascular injury.
  
  
  METHODS
  This is a retrospective analysis of patients admitted with isolated peripheral vascular injury to our Level 1 trauma center between 2006 and 2012. Demographics, presentation, substance use, resuscitation, operative management, intensive care needs, and length of hospital stay were analyzed.
  
  
  RESULTS
  From 257 patients admitted, 158 patients experienced isolated peripheral vascular injury. Patients were subdivided by blood alcohol level (BAL) and urinary toxicology (utox) screens; negative BAL/negative utox (nonintoxicated, n = 90), negative BAL/positive utox (drug users, n = 27), positive BAL/negative utox (alcohol users, n = 22), and positive BAL/positive utox (polysubstance users, n = 19). Compared with nonintoxicated patients, more polysubstance users experienced lower-extremity injury (79% vs. 47%) and presented more often than alcohol users with proximal injury (83% vs. 45%), lower-extremity injury (79% vs. 36%), and as a result of assault (68.4% vs. 31.8%). Polysubstance users required greater resuscitation, more operations, and more frequently experienced complications than any other cohort. Subsequently, these patients had a greater need for intensive care management and longer hospital stay than nonintoxicated and alcohol users. Moreover, using multivariate logistic regression analysis, we found that polysubstance use, alcohol use, and lower-extremity injury are each independent risk factors for infectious complications.
  
  
  CONCLUSIONS
  Our data show that polysubstance users with isolated peripheral vascular injury experience more proximal and lower-extremity injuries, require greater resuscitation, and undergo more operations compared with nonintoxicated patients. Treatment of these patients is more frequently complicated by infection, vascular complications, and increased hospital length of stay.
authors.affiliation: Department of Physiology, Comprehensive Alcohol Research Center, Louisiana State University Health Science Center, New Orleans, Louisiana 70112, USA.
authors.forename: John Nicholas
authors.initials: JN
authors.lastname: Melvan
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mooney
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Bagby
authors.forename: John Patrick
authors.initials: JP
authors.lastname: Hunt
authors.forename: Robert
authors.initials: R
authors.lastname: Batson
authors.forename: Patrick
authors.initials: P
authors.lastname: Greiffenstein
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000009:adverse effects*; D000435:Alcoholic Intoxication / Q000150:complications; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D012151:Resuscitation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications*; D014193:Trauma Centers / Q000706:statistics & numerical data; D057772:Vascular System Injuries / Q000150:complications* / Q000601:surgery / Q000628:therapy